2016


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2016/№2

Angiographic semiotics of coronary lesions in IHD patients with low left ventricular ejection fraction

Kurbanov R. D., Fozilov Kh. G., Abdullaev T. A., Tsoy I. A., Karimov A. M.
Republican Specialized Center of Cardiology, Osiyo 4, Tashkent 100052, Republic of Uzbekistan

Keywords: left ventricular dysfunction, semiotics of coronary lesion, IHD

DOI: 10.18087/rhj.2016.2.2142

Background. Pronounced LV dysfunction in IHD is defined as ischemic cardiomyopathy and a predictor of unfavorable prognosis. Studying semiotics of coronary lesion plays a key role in determining the method of myocardial revascularization, particularly in patients with low LV EF. Up to the present, univocal recommendations on a revascularization method have not existed for such patients. Aim. To study semiotics of coronary lesion in IHD patients with low LV EF. Materials and methods. Between January 1, 2013 and December 1, 2014 selective coronary angiography was performed for 1728 patients with CVD. Selective coronary angiography was performed in 242 (14.1%) IHD patients with LV EF <45%. Results. In 138 IHD patients with low LV EF, athero­sclerotic lesions were found in 343 arteries, i.e., 2.4 arteries per patient on the average. According to data of selective coronary angiography. 28.3 % (39) of patients had one-vessel disease and 71.7 % (99) of patients had multi-vessel disease. Most frequently lesions were located in the anterior interventricular branch (AIVB), 130 (37.9 %); in the right coronary artery (RCA), 71 (20.7 %); in the circumflex artery (SB), 62 (18.1 %); obtuse marginal branch of the circumflex artery (OMB CA), 28 (8.2 %); in the diagonal branch (DB), 18 (5.2 %); in the posterior interventricular branch (PIVB), 14 (4.1 %); in the intermediate artery (IA), 6 (1.7 %); and in the posterior-lateral branch (PLB), 4 (1.2 %). Hemodynamically significant (≥50 %) lesions of the left coronary artery (LCA) trunk were observed in 10 (2.9 %) cases. Quantitative analysis of affected coronary artery segments showed that stenosis of different severity (from 50 to 99 %) occurred in 312 (78.2 %) segments; total occlusion – in 74 (18.9 %) segments; and functional occlusion – in 15 (3.9 %) segments of the coronary vasculature. Conclusion. Not only occluding but also constrictive coronary lesions can decrease LV EF. In this process, mean LV EF values do not significantly differ in patients with one-vessel, two-vessel or three-vessel disease. However, three-vessel coronary lesions were observed significantly more frequently in patients with EF <35% than in patients with one-vessel disease.
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